STORY ARCHIVE

The Female Reproductive Organs

Trusted doctor and anatomist Alice Roberts returns in the second series of ‘Don’t Die Young’. Taking viewers on a tour of the human body, this is Dr Alice’s friendly and informative guide to healthy living.

In episode two, Dr Alice continues her tour of our reproductive systems – this time looking at the female sexual organs. And unlike last week, these are organs Dr Alice is in possession of herself so she can use an MRI scanner on her own body to demonstrate how everything fits together … possibly a first for a television presenter,

“…so there we go, my vagina on national television, my mum would be proud.”

The female body is at its most fertile when women are young and often unlikely to be interested in having children. Rachel Macfarlane, who joins Dr Alice on a journey of discovery is typical of many career women. She’s 24 and a newly qualified solicitor in Manchester; she’d like to find out more about her body and her fertility but admits that she’s no plans to have children anytime soon.

Using Dr Alice’s trademark dissections of animal parts, drawings and props – thousands of chocolate mini eggs are used to demonstrate the huge number of eggs a baby girl is born with and how the immediately start disintegrating – the female reproductive organs are explained. Dr Alice even rolls down a hill in a giant plastic ball to demonstrate the journey of a female egg once it leaves the ovaries.

There’s also advice on how to become “breast aware” – Rachel’s mother recently beat breast cancer – as well as the importance of protecting yourself from sexually transmitted infections and the value of smear tests for fighting cervical cancer.

Dr Alice witnesses the birth of a baby girl and examines some new scientific research which suggests that women advertise their most fertile times to men without even realising it themselves.

TRANSCRIPT

Alice: Oh my God!

Narration: Our bodies are extraordinary, we throw all sorts at them and they hardly ever let us down.

Inside us, every part is constantly working away – all cogs in an amazing machine.

This is my user guide to the female reproductive organs.

Narration: And if we’re going to look at how the female reproductive organs work, where better to start than at the very beginning – or is it more like the very end? – with a visit to a maternity hospital.

Alice: Oh it’s just amazing. This is a new baby girl and, this is what reproduction organs are for. Without them, life – birth – wouldn’t be possible

Narration: It’s a third daughter for Malcolm and Susan Turner.

Like all babies, Kassie’s sex was determined at conception but it didn’t become physically obvious until about seven weeks later. Until then the embryo had a beating heart, limbs and a brain but a completely ambiguous set of genitals.

But after week seven, the genes that control sexual development kick in, and this little girl started on the very first part of her journey to being a woman.

Hidden away in a woman’s body deep within the pelvis, are two ovaries. They contain all the eggs she will need to last her lifetime. The eggs which when fertilized by sperm, create an embryo.

Even before birth, the ovaries are brimming with eggs. But how many are there in a newborn baby girl?

Alice: Right. Each one of these tiny little chocolate eggs represents one of the eggs in the ovaries of a newborn baby girl, and there’s a thousand of them in this basket, but that’s not enough. Five thousand isn’t enough either. It’s not even five hundred thousand eggs – that’s half a million. It’s closer to seven hundred thousand eggs that each woman has in her ovaries when she’s born. And in fact those eggs represent just a fraction of the millions that she had as an embryo. The numbers decline and continue to decline from birth, all the way to the menopause.

Narration: From the moment a woman’s born her biological clock starts to tick. But it’s not something Kassie has to worry about just yet.

Alice: And like many twenty something’s the ticking of her biological clock is not really registering yet for career girl Rachel Macfarlane. At twenty-four, she’s just starting out in the legal profession in Manchester. At the moment her career is all consuming and thoughts of family have taken a firm back seat.

Rachel: Too many balls in the air at the moment I think trying to juggle, without having to think about…think about children as well. I still think…I think I’m about seventeen still. It hasn’t really dawned on me that, I’m mid twenties, suddenly. Should I be thinking about these things? So, perhaps it’s something I should start to think about but no, not at the moment. No.

Narration: Usually at this point I paint the organ on Trevor, but I’m not sure he can help with the female reproductive system.

Alice: Oh! Sorry Trev, we don’t actually need you in this programme.

Narration: So, I’m going to use a torso of a different kind.

Of all our organs, the reproductive ones are possibly the ones we’re most interested in, and by painting them on this model, I can show exactly where they sit in the pelvis.

Alice: So while the male reproductive system is largely on the outside for everyone to see, the female reproductive system really is tucked away inside, deep within the pelvis. And it provides a site not only for fertilization to occur – something that requires a bit of co-operation from the male – but it also provides somewhere where the embryo can develop into a baby.

Narration: I want to show Rachel what these organs really look like. So time for her to take a short break from her career to come to see me in the lab.

Rachel: I’ve heard that we’re doing a dissection so I’m a bit worried about that because when I was in biology GCSE, we did a dissection of some lungs and the teacher went in the bucket, held up the lungs and I burst into tears, and had to leave the room.

Narration: Let’s hope Rachel is now made of sterner stuff, because I want to show her where the female reproductive organs are before we start exploring how best to look after them…

Alice: Well welcome to the lab. I’ve got a dissection that I’ve prepared here which shows all the bits of the female reproductive system. This is in a pig.

Rachel: Okay.

Alice: So immediately behind the pubic bones, is this organ here.

Rachel: The bladder?

Alice: Absolutely. Yes. So there’s the bladder. And, just the same in us, it sits just behind the pubic bone. And then if we pull it forwards, we should be able to see something behind it. And this – believe it or not – this very long slender thing here, is this pig’s uterus.

Rachel: Right.

Alice: And this is obviously quite small, I mean this is in a very young pig, but it’s also a different shape to the uterus in a human. So coming out the top of the uterus, can you see these rather wiggly convoluted tubes?

Rachel: Yes.

Alice: What do you think those are?

Rachel: The fallopian tubes.

Alice: They are. Yeah, absolutely. Also known as oviducts.

Rachel: Right.

Alice: And in fact if we follow one to the very end, we get to a little organ. Guess what that is.

Rachel: An ovary?

Alice: Yes it is. Absolutely. So there should be one on both sides. There we go.

Rachel: Oh wow!

Alice: See there are the…the pig’s ovaries.

Rachel: Yes.

Alice: They are tiny.Rachel: Mmh.

Alice: Our ovaries are quite a bit bigger than that. Probably about four centimetres long.

Rachel: Oh right.

Alice: So you can see the way that things fit in the pelvis, and we’ll see that same organisation of the way that things empty out. So the urethra emptying out of the bladder, is going to be the thing which is most at the front.

Rachel: Right.

Alice: Then there’s going to be the vagina which is obviously coming down from the uterus, so that’s that opening just there.

Rachel: Right.

Alice: See that?

Rachel: Yes.

Alice: And then of course the rectum eventually turns into the anal canal, and there it is. And because this is a pig, a tail.

Narration: I’m about to get up close and personal now with my own reproductive organs. It’s not often you get a chance to see your own uterus and ovaries, hidden as they are in the pelvis.

MRI or magnetic resonance imaging, is a non invasive way of seeing the organs of the body in detail, without exposing the patient to a dose of radiation.

I’m lying inside a large, cylinder-shaped magnet.

The radiographer lines up the scanner to my pelvis and then the computer captures the images of slices through my body, one every 3 millimetres.

Alice: Right so here are the scans I’ve just had done. Right. So this is a central line right down the centre of my body like that. We can see the end of the spine at the back here, so this is the sacrum coming down to the coccyx at the bottom down there. At the front there you can see where the two pubic bones come together, the pubic synthesis. And then in between those two, are all the pelvic organs crammed in.

There’s the bladder, looking quite empty at the moment. There’s the urethra. I’m saying THE urethra, this is actually MY urethra, these are MY organs. This is the uterus, up here. So this lovely pear-shaped organ. So the vagina will be coming down behind the bladder, and then behind that is the rectum. Just there.

Now this scan here is a section through the body in this direction. So, a horizontal slice or an axial section through the body. But I’m hoping to be able to see… Yes! I can…well I can see one anyway.

That is my left ovary. That little structure just there. Taking successively lower sections now, what we can see quite nicely are these black lines here and here, which represent the very bottom of the pelvic floor muscles, coming together like that and just holding those pelvic organs up inside in the pelvis.

This is all the fat on my bottom. And we can see basically the tubes exiting the pelvis here. There’s my urethra at the front there, there’s the anal canal at the back. And sandwiched between the two, is the vagina. So there we go, my vagina on national television. My mum would be proud.Because those tubes all leave a woman’s body in the same area, it’s essential that when little girls are first learning about personal hygiene and are starting to be toilet trained, one of the first things they learn should be to wipe from front to back.

Toddler: Oh No!

Narration: This reduces the risk of bacterial infections being carried forward from the anus to the other organs.

In ten years time or so, this toddler will be packing away her toys and heading towards the dreaded world of puberty.

There she’ll find make-up, music and an addiction to mobile phones. But there are also lots of physical changes taking hold of her body.

One of the major changes inside is that she’ll start ovulating, which is when the ovary releases an egg ready for fertilisation.

Alice: Up until puberty the immature eggs stay put in the ovary, but at puberty the sex hormones kick in and the eggs start to mature. Each month one egg is released and goes on a journey along the tubes of the female reproductive system. So with the help of this enormous egg-like ball, I’m going to map out that journey.

Ready.

Oh! Not very manoeuvrable.

Narration: Once a month just one egg usually leaves an ovary and travels down the fallopian tube or oviduct.

Alice: I’m just going to pause here a moment and wait and see if a sperm comes along.

Narration: For the woman to become pregnant, the egg ideally needs to be fertilised in the next 24 hours.

Alice: I’m gaining speed now

Narration: If it’s not fertilised in time, it will be shed as is the whole lining of the uterus. This is menstruation or, a period.

Alice: I’m gathering speed as I come down the vagina. (laughs)

Oh! Oh! And that’s it. Until of course the next month. Oh! When it all happens again. Do I have to do it again? Oh!

Narration: But when ovulation starts as part of puberty, how many of the 700,000 eggs a woman was born with, does she have left? Well the numbers have been declining since before birth. The eggs develop inside small clusters of cells or follicles. Some follicles will mature and release their eggs, but most of them will simply disintegrate

Alice: So Rachel we’re standing here at Old Trafford cricket ground, bizarrely surrounded by 700 baskets of tiny chocolate eggs, and in fact that makes 700,000 eggs in total. And the reason we’ve got all these eggs around us is that that number represents the number of eggs that we both had in our ovaries when we were born.

Rachel: Then it’s just thousands.

Alice: Yes. A phenomenal number, isn’t it? But they’re actually declining. They were declining before we were born and they carry on declining after birth. And in fact even before we start ovulating, if you…if you say we start at 700,000 at birth, by the time we start ovulating in fact, more than half of those have gone.

Rachel: Really?

Alice: Yes. And there’s just 300,000 left when they actually start coming out of the ovary.

Narration: And with puberty come more obvious and dramatic physical changes. Breasts come in all shapes and sizes, they are part of the female reproductive system, and they are with you for life. So it’s never too early to start checking for potential problems. After all, there are more to breasts than meets the eye.

I’ve brought Rachel to a breast unit, so we can both learn how best to look after our own assets. But we’ve also brought some extra breasts with us…

Alice: And they are very large breasts actually.

Rachel: There’s a lot there.

Lesley: You’ll certainly need a bigger bra, won’t you?

Rachel: I know. Yes.

Alice: I was going to say they’re preserving our dignity but I’m not sure if they are Rachel. (laughter)

Narration: Well they might look silly but what the strap on breasts show very clearly is how much surface area women have to cover when checking for lumps and bumps.

Lesley: They’re very realistic in some ways. They do illustrate a very good point which is how much breast tissue a normal person has. Real breasts come right up almost…the breast tissue comes right up to under the collar bone which is not the bit you think about when you’re imagining, you know where are my breasts?

Alice: Mmh.

Lesley: You just think about these droopy bits, don’t you? And it also goes right up to your armpits and right up here

Alice: So the shape sort of goes all the way around here and then has a sort of tail.

Lesley: Yes.

Alice: Which goes right up into the armpits.

Lesley: Yes. Yes. And…and…

Alice: Yes.

Lesley: Do you want to take them off? I think… Have you been silly for long enough?

Alice: In terms of…in terms of technique of examination Lesley, I mean what…what are the important points there?

Lesley: The important point really is not about technique.

Alice: Right

Lesley: The important thing is, know what your breasts look like. Always use the flat of your hand, with the soap, with the cream – whatever. You’re looking for lumps, you’re looking for little lurky bits, you’re looking for breasts that look uneven. You’re looking for size that isn’t quite right, isn’t quite together. Most women have breasts that are not the same size. And then you’ll just get so used it, you can pick up a change without really thinking about it

Rachel: My Mum actually found a lump in her breast just by being generally breast aware as you’ve been saying Lesley.

Lesley: Yes.

Rachel: So obviously, it is important to be aware of what’s going on and to get things checked out.

Lesley: And what happened to your Mum?

Rachel: She found a lump and quickly got it removed and went through her chemo and her radio and, five years later in April, she got the all-clear. Five years ago. She…she’s doing well.

Lesley: Well I mean I hope you never have the problem.

Rachel: Thank you.

Lesley: But stay aware.

Rachel: Yes.

Narration: The end of puberty means that girls are now women and boys are now men. Physically they are now ready and able for sexual activity. And with that comes added responsibility, and the need for protection.

Alice: As soon as someone becomes sexually active, it’s absolutely essential they start thinking responsibly about sexually transmitted infections. Now we’ve known for centuries how to prevent these infections and lower the risk of getting them. And here it is – the condom. But sexually transmitted infections are on the increase in the UK.

Narration: If left untreated, some sexually transmitted infections can lead to infertility, and in extreme cases, they can be fatal.

But many are curable, and all are preventable.

The two most common sexually transmitted diseases look like this under the microscope.

But we’re not going to use a microscope, we’re going to use cuddly toys based on those slides. And I wonder if anyone can guess what infections they are?

Oh I think it’s Salmonella. Something green and horrid. (laughs)

I don’t know. Gastroenteritis?

We don’t think we have it. (laughter)We don’t think…no, we hope we don’t have it.

Believe it or not, it’s actually a giant Chlamydia microbe.

Chlamydia is particularly prevalent among young people – studies have shown that 1 in 10 women under 25 maybe infected. And it often has no symptoms, but can lead to serious fertility problems later in life.

But how about this little fella?

Will I touch it? No. You’ve just told me it’s got a virus.

It’s looking at me now.

It’s thinking – I know you.

Gonorrhoea?

Yes it’s Gonorrhoea.

Group of women: Oh!

Narration: Gonorrhoea is most common amongst young men and women. Again it may have no symptoms, but it can cause damage to a woman’s fallopian tubes and ovaries.

But there’s one sexual disease that has even more serious consequences. It’s a virus that can cause cancerous changes in the cervix, the opening of the uterus. This infection is so common that half of all women will have been exposed to it within the first four years of having sex.

Alice: If you’re sexually active, it’s very likely that you’ve been exposed to HPV, the Human Pathaloma Virus. About one in a hundred people who have HPV infection develop genital warts but, the vast majority have no signs or symptoms at all. But the infection does have very worrying consequences because almost all cases of cervical cancer, are associated with HPV infections.

Narration: That’s why regular smear tests are so important. When a sample of cells are taken from the cervix, pre cancerous and cancer cells can be identified before it’s too late.

Nurse: This is the speculum Sarah and we’re going to introduce it as far as the cervix. It can be a bit uncomfortable but it shouldn’t be painful.

Narration: But there’s always been a bit of reluctance on the part of women to have regular smear tests, because of the anxiety, embarrassment and discomfort.

But new technological advances have been made to the cervical screening programme in Britain, which Rachel is keen to see.

The old conventional method of collecting the smear with a wooden spatula is out - there’s too much chance of blood contaminating the sample - and in comes a plastic brush. It causes less discomfort and gives a much clearer reading.

Dr. Desai: One in ten women we used to say come back because we haven’t got enough cell or we can’t see your cells. With this, now only three to four women out of a hundred we say come back.

Rachel: So there are benefits all round then.

Dr. Desai: Absolutely, for woman and also for the…for us, looking down the microscope it’s much easier.

Narration: Every year a 1,000 women die of cervical cancer in the UK. But it’s also estimated that 4,500 lives are saved through cervical screening.

It’s important for a woman to know her body and also to know her monthly cycle.There are usually only a few days each month when she is actually fertile and could get pregnant. Those few days are around the time of ovulation, about 14 days after the start of her period.

In the animal world that fertile period is called being on heat or in season. So I’ve brought Rachel to the zoo so that with the help of some animal friends...

Alice: They look like enormous beavers don’t they?

Narration: …I can explain the intricacies of our fertility better.

Alice: So Rachel these are the guys and the girls that I really wanted you to see today. So these are common chimpanzees, and they are our closest relatives. In there we’ve got a few females and a couple of males. And then amongst the females – most of them are actually out of season at the moment - but there’s one that’s in season.

Rachel: Right.

Alice: And it’s…and that’s quite obvious. So have a look and see if you can spot which one it is.

Rachel: Is it that one over there?

Alice: Yes. Absolutely. That’s Holly.

Rachel: Right.

Alice: And you can see…you can see the signal that she’s…that she’s basically sending off. I mean she’s got this enormously swollen bottom, it’s very pink and swollen. And that’s there for about a week in the cycle. Do you think there’s any signs that we send out?

Rachel: Well I don’t have a pink bottom. I’m not aware of any other signals we have.

Alice: Well there might be some but they’re going to be a lot more subtle than that!

Rachel: Right!

Narration: Could it be that women also give out signs when they’re at their most fertile? Well it would seem that there’s now some evidence to suggest we do.

Through a series of diaries kept by a group of dancers, scientists examined the tips that men gave them to perform.

During her period the average amount that a woman would earn for a 5 hour shift was $185. In the phase of her cycle when she wasn’t fertile it was $260. But when she was ovulating and at her most fertile, it rose to $335.

So when the women were at the peak of their fertility they earned significantly more money, despite there being no obvious change in their physical appearance. The study appears to show that somehow the women were inadvertently advertising their fertility to the men. So subconsciously both sexes were involved in recognizing these mysterious fertility signals. Women are giving off covert signals in some way and men are responding to them.

And the evidence doesn’t stop there. It could be that, without knowing it, even in the way we dress every day, all women are displaying their fertile and non- fertile times of the month.

In a second academic study, 30 women posed for two photographs. One photograph was taken on a high fertility day of the cycle and one on a low fertility day.

Then their faces were obscured.

The two photographs were then judged by a mixture of men and women who were asked, “In which photo is the person trying to look more attractive?”

The results indicated that 60% of the time it was when the women were at their most fertile that the judges thought they had tried to look attractive.

Alice: I think these studies are absolutely fascinating. I mean they might not give us any definite conclusions about what’s going on physiologically, but they certainly show that women seem to be aware of what’s going on inside their own bodies, even if they’re not conscious of it.

Rachel: You need a warning really, don’t you?

Alice: Yes you do.

Narration: But without any warning, sometimes those fertility signals pay off. The most is made of a woman’s fertile time, and she becomes pregnant.

Now I might know what happens anatomically to a woman during pregnancy, but I don’t know how it actually feels. So with the help of this pregnancy belly designed for teenagers or unsympathetic partners, I’m hoping to find out.

There’s an elastic strap which goes tightly round my chest to restrict my breathing, then the belly is filled with 3 and a half litres of warm water. And lead weights are added, to simulate the baby’s knees and elbows digging in to my internal organs.

Alice: Ah!

It’s incredibly heavy.

I’ve got extra specially large boobs, look at that.

I’ll have a little walk around with this and, I’m going to have a go cycling as well. I’m not sure whether that’s advisable in my state.

Narration: So I’m suddenly 9 months pregnant and carrying round an extra 2 stone, which can make even the simplest task, surprisingly difficult.

Alice: Ah it’s actually quite tiring and I feel a real wimp saying this because obviously there’s a lot of people walking around like this at this very moment, but actually for real. And it makes you walk in a different way, your hips are working slightly differently and I’m also a bit breathless as well because of that band around my chest. Now, walking is all well and good but I normally get around using this contraption.

I absolutely would not recommend that for somebody who’s really as pregnant as I’m pretending to be but, I just thought it would be rather interesting to have a go.

Ooh! That was pretty uncomfortable.

Oh! Well, certainly having babies isn’t easy.

But, I can take this off now. In fact, can I take it off now please?

Narration: A normal weight gain during pregnancy is between 22 to 28 pounds. That’s the weight of the baby, pregnant uterus, placenta, extra blood, amniotic fluid and additional fat stores.

And whilst a man’s ability to father a child continues indefinitely, a woman’s fertility has a sell by date.

Nothing Rachel has to be unduly concerned about though. In your mid-twenties you still have around a 100,000 eggs. But in 10 years or so, she’ll start to hear the ticking of her biological clock and after that, the days of her fertility are numbered.

Alice: Your eggs will carry on declining in number as you get older as well. In fact, by the time you’re in your late thirties, they’re down to about 25,000. And then the decline gets faster and faster and faster, until by the time you hit the menopause, you’re just down to a thousand.

So there we go, just one basket of eggs left at the end. And in fact, although it seems remarkable that we’ve gone from 700 baskets to one basket, even that one basket actually contains more eggs than you really need in your life. Because if you were to add up all the months between the start of ovulation and the finish of ovulation, you only actually need about four or five hundred eggs

Rachel: Oh right.

Alice: And you only need one to make a baby.

Rachel: Yes.

Narration: And the baby girl, Kassie, whose birth I was privileged enough to witness, is now settled in at home with her two sisters.

Rachel is enjoying a night out with her high flying legal colleagues, having learnt more about how amazing the female body is.

Rachel: Every time I go back to work or go and see my friends or, go home, I’m telling them all about it. You’ll never guess what, we’re born with 700,000 eggs or, chimps feel… You know, things like that so yeah everyone, everyone thinks it’s really interesting and, it’s been good. Yes.

Narration: I’ve learnt things too. I’ve learnt what it’s like to be an egg, making its way through the reproductive system. I’ve seen my own reproductive organs, and I’ve learnt the importance of breast awareness, though I think I’ll be leaving the strap-on breasts in the box.

Next time I’ll be looking at the biggest internal organ – the liver. How it rarely complains until it’s too late.

Surgeon: This is typical appearance of a cirrhotic liver.

Narration: How we put it under pressure.

Lady: Six shots of vodka.

Narration: And how the umbilical cords of newborn babies, are being used to create brand new livers.